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SINGAPORE: All healthcare institutions in Singapore could soon be required to contribute data to the National Electronic Health Record (NEHR), in a move aimed at providing better care for patients.

Legislation is set to be introduced next year through a Healthcare Services Bill, Health Minister Gan Kim Yong said at the first FutureHealth conference held at Nanyang Technological University’s Lee Kong Chian School of Medicine on Wednesday (Nov 8).

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“Patients can only realise the full potential of the NEHR if the data is comprehensive. And for NEHR data to be comprehensive, every provider and healthcare professional needs to contribute relevant data to it,” Mr Gan said.

“MOH (Ministry of Health) therefore intends to take the next major step for the NEHR to require mandatory data contribution by all licensees, such as healthcare providers and laboratories, so as to improve data comprehensiveness for better patient care.”

Set up in 2011, NEHR is a platform that brings together patient records such as their medication and laboratory reports from different care providers. The information is shared across providers.

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Currently, contribution is voluntary with close to all public institutions contributing patient data but just 3 per cent of private healthcare providers do so. This represents a significant gap in the data available on the platform, says the Integrated Health Information Systems (IHiS), the nation's health tech agency which manages the NEHR.

FEW PRIVATE CLINICS ON BOARD

In the primary care sector for example – where about 80 per cent of Singaporeans visit private general practitioners instead of polyclinics – less than 70 out of 1,600 GP clinics contribute data to the NEHR.

One reason is that not all GPs have gone digital.

For Dr Ajith Damodaran, the most extensive form of digital recordkeeping he has is a spreadsheet of his patients’ names, address and the file number of their physical patient file.

He said it is not so much a matter of cost, but his level of comfort with technology.

“I can't type fast enough. Whereas I can write in short form, draw diagrams whenever I need to and things like that. I still feel very comfortable doing that,” said the 63-year-old general practitioner.

Without an IT system that tracks his patients' health records, he is not able to contribute their data to the NEHR. However, he has used the database, which is accessible through an online portal, to get information on his patients who have been recently discharged from the hospital, such as the tests that were done.

While he acknowledged that sharing of information is important, he has no plans to digitise his records yet.

“I’ll wait and see until the law is passed,” said Dr Damodaran.

Dr Ajith Damodaran is one of the many GPs in Singapore who does not keep digital records of his patients. (Photo: Chan Luo Er)

An estimated 20 per cent of private healthcare providers still rely on a pen-and-paper system. Even for those who are digitally ready, they will have to ensure their IT systems are compatible with the NEHR.

There will be a new S$20 million fund to defray the cost of upgrade, as well as technical and clinical support.

“To effectively upgrade and connect all these systems to NEHR, in a way we want it to be, in a safe and secure manner, with the right standards – it is a tall challenge by itself," said Mr Bruce Liang, CEO of IHiS.

"Firstly, there is the human factor about a certain amount of resistance, and the technical challenge is another aspect. So overall, it is going to be a challenging project to get everyone on board."

CONCERNS OVER PRIVACY

Since the NEHR was set up, concerns have been raised over issues like privacy. For example, job applicants who need to go for a medical check-up might not want their full medical history to be shared with their prospective employers - especially if they have a mental illness or sexually transmitted diseases.

But authorities have said that there are safeguards in place to ensure that only those providing care to patients access their records.

For example, healthcare providers use a personal account to log in to the system. Sensitive information will be tucked away, and doctors who require that information will have to use their medical licence number to access it.

“We also perform a significant amount of audits and checks, employing analytics, employing visual checks, manual checks, a combination of all, to look at what may appear to be irregular or illegitimate access to patient information,” said Mr Liang.

Authorities will hold consultations with stakeholders in the coming months. They will also look into how patients can find out who has accessed their information - which could be done through government portal HealthHub.

Healthcare institutions are likely to be given about two to three years to ensure they meet the requirements, if the law is passed.

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